Provider Demographics
NPI:1619917861
Name:JONES, DOLORES L (PA)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S 4TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5948
Mailing Address - Country:US
Mailing Address - Phone:215-339-1079
Mailing Address - Fax:215-952-6966
Practice Address - Street 1:432 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4004
Practice Address - Country:US
Practice Address - Phone:215-925-2400
Practice Address - Fax:215-925-9166
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S95519Medicare UPIN